Mepilex Lite dressings for the management of radiation-induced erythema: a systematic inpatient controlled clinical trial

Erythema occurs in 80–90% of women treated for breast cancer with radiation therapy. There is currently no standard treatment for radiation-induced skin reactions. This study investigates the clinical efficacy of Mepilex Lite dressings in reducing radiation-induced erythema in women with breast cancer. A total of 28 patients were recruited; of these, 24 participants presented with 34 erythematous areas of skin for analysis. When erythema was visible, each affected skin area was randomly divided into two similar halves: one half was treated using Mepilex Lite dressings, the other half with standard aqueous cream. Skin reactions were assessed by the Radiation-Induced Skin Reaction Assessment Scale. We also evaluated any potential dose build-up by the dressings using a white water phantom, the dose distribution over the breast via thermoluminescent dosimeters (TLDs) and the surface skin temperature with an infrared thermographic scanner. Mepilex Lite dressings significantly reduced the severity of radiation-induced erythema compared with standard aqueous cream (p <0.001), did not affect surface skin temperature and caused only a small (0.5 mm) dose build-up. TLD measurements showed that the inframammary fold was exposed to significantly higher doses of radiation than any other breast region (p <0.0001). Mepilex dressings reduce radiation-induced erythema.Breast cancer is the most common malignancy for women in New Zealand. Most of these women will receive radiation therapy treatment, and skin reactions will occur in 80–90% of patients by treatment completion 1]. To date, there is no standard treatment for radiation-induced skin reactions and practice tends to be based on historical and anecdotal evidence 1–3]. A promising new range of Swedish silicon-foam skin dressings, Mepilex Lite (MV Bamford and Company Ltd, Lower Hutt, New Zealand and Mölnlycke Health Care Gothenburg, Sweden) is currently used in New Zealand for the treatment of burns and slow-healing wounds. This absorbent, self-adhesive dressing consists of a thin, flexible sheet of absorbent hydrophilic polyurethane foam bonded to a water vapour-permeable polyurethane film backing layer. The contact surface of the dressing is coated with a soft silicone adhesive layer without any added chemicals. It adheres to healthy skin, thus retaining the dressing in position but without causing trauma on removal, and provides a moist wound-healing environment. The material does not add or react to chemicals in or on the skin, does not stick to wounds and can be left on the skin for several days 1, 4].Preliminary case studies conducted in our department showed that Mepilex Lite dressings reduced the extent of all radiation-induced skin reactions. These results are consistent with previous case studies carried out in Scotland and Stockholm 1, 5]. The current study is the first clinical study that compares the clinical efficacy of Mepilex Lite dressings on the severity of radiation-induced erythema with a standard aqueous cream using the Radiation-Induced Skin Reaction Assessment Scale (RISRAS) (5, 6]. Because anecdotal evidence suggests that the dressings may have a cooling effect, we also determined their effect on surface skin temperature as well as the extent of dose build-up caused by the dressings if they were left on the patient during treatment.

Table 1

Radiation-Induced Skin Reaction Assessment Scale (RISRAS)

RISRAS (total scores between 0 and 36)a
Researcher component (total scores between 0 and 24)
Erythema (E)	0 Normal skin	1.0 Dusky pink		2.0 Dull red		3.0 Brilliant red		4.0 Deep red-purple
Dry desquamation (DD)	0 Normal skin	1.0 (<25%)b		2.0 (25–50%)		3.0 (50–75%)		4.0 (>75%)
Moist desquamation (MD)	0 Normal skin	1.5 (<25%)		3.0 (25–50%)		4.5 (50–75%)		6.0 (>75%)
Necrosis (N)	0 Normal skin	2.5 (<25%)		5.0 (25–50%)		7.5 (50–75%)		10.0 (>75%)
Patient component (total scores between 0 and 12)
Symptoms			Not at all		A little		Quite a bit	Very much
Do you have any tenderness, discomfort or pain of your skin in the treatment area?			0		1		2	3
Does your skin in the treatment area itch?			0		1		2	3
Do you have a burning sensation of your skin in the treatment area?			0		1		2	3
To what extent have your skin reactions and your symptoms affected your day-to-day activities?			0		1		2	3

Open in a separate window^aIndividual scores for each item are added up to give a total score for the researcher and patient components of the scale. Adding the researcher and patient component scores together gives the total combined RISRAS score.^bPercentage of surface area of affected skin.